Print this page    •   Back to Web version of article

The ADAP Watch

February 10, 2012

As of February 9, 2012, there were 4,118 individuals on AIDS Drug Assistance Program (ADAP) waiting lists in 12 states. This is a 38 percent decrease from the 6,595 individuals on the November 2011 ADAP Watch. Eighteen ADAPs, including 10 with current waiting lists, have instituted additional cost-containment measures since April 1, 2009 (reported as of February 1, 2012). In addition, six ADAPs, including one with current waiting lists, reported they are considering implementing new or additional cost-containment measures by the end of ADAP's current fiscal year (March 31, 2012).


ADAPs With Current or Anticipated Cost-Containment Measures, Including Waiting Lists, February 2012

ADAPs With Current or Anticipated Cost-Containment Measures, Including Waiting Lists, February 2012


Waiting List Organization: An ADAP waiting list using a first-come, first-served model is structured to place any individual applying to ADAP on the waiting list in order of receipt of a completed enrollment application and eligibility confirmation. Of the 12 states with ADAP waiting lists, seven ADAPs utilize a first-come, first-served model for prioritizing clients to join the active client roll.

An ADAP waiting list using a medical criteria model is structured based on a hierarchical criteria typically established by the state based on recommendations from its ADAP Advisory Committee. Of the 12 states with ADAP waiting lists, five ADAPs utilize a medical criteria model for prioritizing clients to join the active client roll.

Waiting List Client Demographics: African Americans and Hispanics represent 62% (49% and 13%, respectively) of clients on ADAP waiting lists. Combined, Asians, Native Hawaiian/Pacific Islanders, and Alaskan Native/American Indians represent approximately 2% of the total ADAP waiting list population. Multi-racial ADAP clients represent 1% of the total ADAP waiting list population. Non-Hispanic whites comprise 23% of clients on ADAP waiting lists.

Almost three-quarters (74%) of ADAP clients are men. One quarter (25%) of ADAP waiting list clients are women.


ADAP Waiting List Clients, as of February 1, 2012


Access to Medications: Case management services are being provided to ADAP waiting list clients through ADAP (2 ADAP), Part B (9 ADAPs), contracted agencies (6 ADAPs), and other agencies, including other Parts of Ryan White (5 ADAPs).

For clients on ADAP waiting lists who are currently on or in need of medications, 11 ADAP waiting list states can confirm that ADAP waiting list clients are receiving medications through either pharmaceutical company patient assistance programs (PAPs), Welvista, or other mechanisms available within the state.

Factors Leading to Implementation of Cost-Containment: ADAPs reported the following factors contributing to consideration or implementation of cost containment measures:

ADAPs With Waiting Lists
(4,118 Individuals in 12 States*, as of February 9, 2012)
State Number of Individuals on ADAP Waiting List Percent of the Total ADAP Waiting List Increase/Decrease From Previous Reporting Period Date Waiting List Began
Alabama1193%0October 2011
Florida85021%-130June 2010
Georgia90622%-333July 2010
Idaho20.05%-2February 2011
Louisiana**67216%-18June 2010
Montana120.3%4January 2008
Nebraska862%43October 2011
North Carolina1363%-1January 2010
Ohio00%0July 2010
South Carolina2556%0March 2010
Utah00%0May 2011
Virginia1,08026%-20November 2010

* As a result of FY2011 ADAP emergency funding, Alabama, Florida, Georgia, Idaho, Louisiana, Montana, North Carolina, Ohio, South Carolina, Utah and Virginia were able to reduce the overall number of individuals on their waiting lists.

** Louisiana has a capped enrollment on their program. This number represents their current unmet need.


ADAPs With Other Cost-Containment Strategies: Financial Eligibility
(445 Individuals in 6 States, as of February 1, 2012)
StateLowered Financial EligibilityDisenrolled Clients
Arkansas500% to 200% FPL99 clients (September 2009)
Illinois500% to 300% FPLGrandfathered in current clients from 301-500% FPL
North Dakota400% to 300% FPLGrandfathered in current clients from 301-400% FPL
Ohio500% to 300% FPL257 clients (July 2010)
South Carolina550% to 300% FPLGrandfathered in current clients from 301-550% FPL
Utah400% to 250% FPL89 clients (September 2009)

ADAPs With Other Cost-Containment Strategies (Instituted Since April 1, 2009, as of February 1, 2012)

Alabama: reduced formulary
Arizona: reduced formulary
Arkansas: reduced formulary
Florida: reduced formulary, transitioned 5,403 clients to Welvista from February 15 to March 31, 2011
Georgia: reduced formulary, implemented medical criteria, participating in the Alternative Method Demonstration Project
Illinois: reduced formulary, instituted monthly expenditure cap ($2,000 per client per month), disenrolled clients not accessing ADAP for 90 days
Kentucky: reduced formulary
Louisiana: discontinued reimbursement of laboratory assays
Nebraska: reduced formulary
North Carolina: reduced formulary
North Dakota: capped enrollment, instituted annual expenditure cap
Ohio: reduced formulary
Puerto Rico: reduced formulary
Utah: reduced formulary
Virginia: reduced formulary, restricted eligibility criteria, transitioned 204 clients onto waiting list
Washington: instituted client cost sharing, reduced formulary, only paying insurance premiums for clients currently on antiretrovirals
Wyoming: capped enrollment, reduced formulary, instituted client cost sharing


Advertisement

ADAPs Considering New/Additional Cost-Containment Measures (Before March 31, 2012*)

Alaska: reduce formulary
Florida: lower financial eligibility
Kentucky: reduce formulary
Montana: reduce formulary
Nebraska: disenroll clients based on medical criteria
Oregon: reduce formulary
Puerto Rico: reduce formulary
Tennessee: establish waiting list
Washington: lower financial eligibility
Wyoming: establish waiting list, lower financial eligibility, institute client cost sharing


Outlook for FY2012

ADAPs Considering New/Additional Cost-Containment Measures (before March 31, 2013**)

California: resulting from state budget crisis
Nebraska: resulting from increased ADAP enrollment
Washington: resulting from state budget decreases and increasing insurance premium costs
Wyoming: resulting from state budget decrease


Not Yet Determined

Alaska
Arizona
Arkansas
Hawaii
Iowa
Kentucky
Louisiana
South Carolina
Tennessee

About ADAP: ADAPs provide life-saving HIV treatments to low income, uninsured, and underinsured individuals living with HIV/AIDS in all 50 states, the District of Columbia, the Commonwealth of Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, the Federated States of Micronesia, American Samoa, and the Republic of the Marshall Islands. In addition, some ADAPs provide insurance continuation and Medicare Part D wrap-around services to eligible individuals. Ryan White Part B programs provide necessary medical and support services to low income, uninsured, and underinsured individuals living with HIV/AIDS in all states, territories and associated jurisdictions.

* March 31, 2012 is the end of ADAP FY2011. ADAP fiscal years begin April 1 and ends March 31.

** March 31, 2013 is the end of ADAP FY2012. ADAP fiscal years begin April 1 and ends March 31.




This article was provided by National Alliance of State and Territorial AIDS Directors. You can find this article online by typing this address into your Web browser:
http://www.thebody.com/content/65976/the-adap-watch.html

General Disclaimer: TheBody.com is designed for educational purposes only and is not engaged in rendering medical advice or professional services. The information provided through TheBody.com should not be used for diagnosing or treating a health problem or a disease. It is not a substitute for professional care. If you have or suspect you may have a health problem, consult your health care provider.